Accelerated treatment of endocarditis-The POET II trial: Rationale and design of a randomized controlled trial.

Abstract:

BACKGROUND:The optimal antibiotic treatment length for infective endocarditis (IE) is uncertain. International guidelines recommend treatment duration of up to 6 weeks for patients with left-sided IE but are primarily based on historical data and expert opinion. Efficacies of modern therapies, fast recovery seen in many patients with IE, and complications to long hospital stays challenge the rationale for fixed treatment durations in all patients. OBJECTIVE:The objective was to conduct a noninferiority randomized controlled trial (acronym POET II) investigating the safety of accelerated (shortened) antibiotic therapy as compared to standard duration in patients with left-sided IE. METHODS:The POET II trial is a multicenter, multinational, open-label, noninferiority randomized controlled trial. Patients with definite left-sided IE due to Streptococcus spp, Staphylococcus aureus, or Enterococcus faecalis will be eligible for enrolment. Each patient will be randomized to accelerated antibiotic treatment or standard-length treatment (1:1) following clinical stabilization as defined by clinical parameters, laboratory values, and transesophageal echocardiography findings. Accelerated treatment will be between 2 and 4 weeks, whereas standard-length treatment will be between 4 and 6 weeks, depending on microbiologic etiology, complications, need for valve surgery, and prosthetic versus native valve endocarditis. The primary outcome is a composite of all-cause mortality, unplanned cardiac surgery, relapse of bacteremia, or embolization within 6 months of randomization. CONCLUSIONS:The POET II trial will investigate the safety of accelerated antibiotic therapy for patients with left-sided IE caused by Streptococcus spp, Staphylococcus aureus, or Enterococcus faecalis. The results of the POET II trial will improve the evidence base of treatment recommendations, and clinical practice may be altered.

journal_name

Am Heart J

journal_title

American heart journal

authors

Østergaard L,Pries-Heje MM,Hasselbalch RB,Rasmussen M,Åkesson P,Horvath R,Povlsen J,Gill S,Bruun NE,Müllertz K,Tuxen CD,Ihlemann N,Helweg-Larsen J,Moser C,Fosbøl EL,Bundgaard H,Iversen K

doi

10.1016/j.ahj.2020.05.012

subject

Has Abstract

pub_date

2020-09-01 00:00:00

pages

40-46

eissn

0002-8703

issn

1097-6744

pii

S0002-8703(20)30156-3

journal_volume

227

pub_type

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